Provider Demographics
NPI:1710085238
Name:NEIL G BARRY III MD INC
Entity Type:Organization
Organization Name:NEIL G BARRY III MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:606-248-4162
Mailing Address - Street 1:3004 W CUMBERLAND AVENUE
Mailing Address - Street 2:MEDICAL ARTS BUILDING
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965
Mailing Address - Country:US
Mailing Address - Phone:606-248-4162
Mailing Address - Fax:606-242-3429
Practice Address - Street 1:3004 W CUMBERLAND AVENUE
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-4162
Practice Address - Fax:606-242-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65931263Medicaid
KY65931263Medicaid